π Arthrotec is a preparation of diclofenac (NSAID) combined with misoprostol, a prostaglandin analogue, which helps reduce NSAID-induced gastrointestinal side effects such as ulcers and bleeding.
π About
- Always check the BNF link here for updated dosing and safety guidance.
- Diclofenac is a widely used NSAID with analgesic, anti-inflammatory, and antipyretic properties.
βοΈ Mode of Action
- π§ͺ Inhibits prostaglandin synthesis by reversibly inhibiting cyclo-oxygenase (COX) enzymes.
- COX-1 β protective prostaglandins (gastric mucosa, platelets, renal blood flow).
- COX-2 β inducible, mainly in inflammation (pain, swelling, fever).
- β‘ Diclofenac is relatively short-acting (short elimination half-life), limiting accumulation.
π Dose Range (check BNF/datasheet)
| Name | Starting Dose | Frequency | Route |
| Voltarol (standard) | 50 mg | TDS | PO |
| Voltarol Slow-Release | 75 mg | OD or BD | PO / PR |
| Voltarol Suppository | 100 mg | Stat | PR |
π Interactions
- π See BNF for complete list.
- β οΈ Increased risk of GI bleed with corticosteroids, SSRIs, and anticoagulants.
- π Can reduce antihypertensive effect of ACE inhibitors, ARBs, and diuretics.
- β Risk of renal impairment with other nephrotoxic agents (e.g., aminoglycosides).
β οΈ Cautions
- π
Avoid long-term use if possible β use the lowest effective dose for the shortest duration.
- β‘ Monitor renal function, especially in elderly or dehydrated patients.
- π« Use with caution in asthma (risk of bronchospasm).
β Contraindications
- π« Active or history of peptic ulcer disease or GI bleeding.
- π« Severe renal impairment, dehydration.
- π« Cardiovascular disease: IHD, CCF, PVD, haemorrhagic stroke (β risk of CV events with diclofenac).
- π« Hypersensitivity to NSAIDs (e.g., asthma, urticaria, anaphylaxis).
π¬ Side Effects
- π€’ GI disturbance: dyspepsia, abdominal pain, nausea, diarrhoea.
- π©Έ Serious risk: peptic ulceration, GI bleed, perforation.
- π§ Fluid retention, oedema, hypertension.
- π§ͺ AKI (especially in dehydration or CKD).
- π§΄ Skin reactions: rashes, photosensitivity, rare StevensβJohnson syndrome.
π References
- BNF: Diclofenac
- NICE guidelines on Osteoarthritis and Chronic Pain management.
π Revisions